Chronic cough (CC) lasting ≥ 8 weeks disproportionately affects women, and its prevalence increases with age. At the 30th edition of the Congrès de Pneumologie de Langue Française 2026 in France, Laurent Guilleminault, MD, PhD, pulmonologist at the Department of Respiratory Medicine, Faculty of Medicine, Toulouse University Hospital, Toulouse, France, outlined possible causes, including biological, clinical, and psychosocial factors.

With advancing age, the proportion of women among the affected individuals increases. Guilleminault cautioned that selection bias must be considered because women may be more likely to consult doctors for CC. Thus, psychosocial factors may play an important role in CC development. Women may be less tolerant of persistent coughing and more sensitive to social perceptions and associated embarrassment.

Comorbidities and Factors

Several comorbidities that predominantly affect women may contribute to CC, including gastroesophageal reflux disease, asthma, and chronic rhinosinusitis.

The larynx may represent the central component. “It is highly innervated, and its innervation is strongly associated with emotions, which is why the voice can tremble under stress,” Guilleminault said.

Individuals with irritable larynx syndrome, characterized by muscular and inflammatory stress of the larynx, may develop functional dysphonia, laryngeal obstruction, or refractory CC. “All of these laryngeal disorders predominantly affect women. Voice changes resulting from laryngeal development during adolescence may follow different trajectories and increase the risk for laryngeal dysfunction and CC, he said.

Evidence remains limited; however, childhood sexual abuse, which is more frequently reported in women, may be associated with vocal cord dysfunction. The underlying mechanisms and true prevalence remain unclear.

The predominance of women among patients with refractory or unexplained CC may also reflect greater cough reflex sensitivity. Across multiple testing methods, women showed stronger responses. According to Guilleminault, this may involve both peripheral receptor hypersensitivity and central mechanisms.

“Negative feedback at the cortical level that modulates the cough reflex when a peripheral signal is transmitted may be more permissive in women,” he said. Current evidence does not implicate female sex hormones or suggest a protective role for testosterone.

Therefore, CC should be considered within a broader biopsychosocial framework, in which social and psychological factors may affect women differently.

Dyspnea, defined as an unpleasant subjective experience of breathing that includes sensory and negative affective dimensions, also shows a clear female predominance. The difference becomes more pronounced after age 50, particularly among women facing social vulnerability such as unemployment or low income.

Capucine Morelot-Panzini, MD, PhD, head of the Department at Hôpital La Pitié Salpêtrière, Groupe Hospitalier La Pitié Salpêtrière-Charles Foix, Paris, France, reported that at equivalent lung function, dyspnea severity is greater in women.

Anatomical differences may partly explain this disparity. Imaging studies have shown a smaller bronchial surface area and airway lumen in women, which is associated with lower lung volumes and reduced expiratory flows, including forced expiratory volume in 1 second and peak expiratory flow.

Dyspnea arises from a mismatch between the respiratory motor command and the mechanical response of the respiratory system, with central integration in the brain. Women may perceive respiratory effort earlier, resulting in a greater reported intensity at comparable ventilation levels.

The integration of motor commands includes both sensory and emotional components. Women may anticipate dyspnea more strongly and experience a greater emotional dimension, increasing the overall symptom burden.

This story was translated from Univadis France, part of the Medscape Professional Network.